Modified Atkins diet helps control drug-resistant epilepsy

Teen and adult patients with drug-resistant epilepsy may benefit from modified Atkins diet, which has been shown in a recent study to produce improvements in seizure frequency, quality of life (QOL), and behavioural problems as compared with standard drug therapy.

The modified Atkins diet combines the Atkins diet and a ketogenic diet, including food items such as leafy green vegetables, butter and oils, soy products, heavy cream, and animal protein such as eggs, chicken, fish, and bacon. This modified version addresses the limitations of ketogenic diet, which, although proven to be effective at reducing seizures, is difficult to follow due to its stringent requirements and restrictions.

In a study, 6 months after initiation of the modified Atkins diet intervention, significantly more patients who adopted the diet in addition to their antiseizure medications achieved a >50 percent reduction in seizures (26.2 percent vs 2.5 percent; p<0.001) than those who received standard drug therapy alone (control). [Neurology 2023;doi:10.1212/WNL.0000000000206776]

The marked reduction in seizure frequency in the diet group occurred together with an increase in QOL (52.1 vs 42.5 in the control group; mean difference, 9.6, 95 percent confidence interval [CI], 4.3–14.9, p<0.001).

Finally, behaviour scores (available in 49 patients) at the end of the study differed significantly between the two groups, with more favourable changes seen among those who received the dietary intervention (65.6 vs 71.4; p=0.015).

“For people with drug-resistant epilepsy, or those who have been unable to find effective treatment to reduce seizures, it's encouraging to see that there are lifestyle changes that can be combined with standard drug therapy to reduce the number of seizures,” said senior study investigator Dr Manjari Tripathi of All India Institute of Medical Sciences in New Delhi, India.

“Our study found that this combination may reduce the chance of seizures by more than half,” Tripathi added.

The study included 160 outpatients aged 10–55 years (80 adults and 80 adolescents) and randomly assigned to either the diet or the control group. These patients experienced more than two seizures/month despite using at least three appropriate antiseizure medications at their maximum tolerated doses and had not been on any form of diet therapy for the past 1 year.

All patients recorded their seizures and meals. Those in the diet group were provided with food lists, sample menus, and recipes. Carbohydrate intake was restricted to 20 grams per day; federal dietary guidelines recommend between 225 and 325 grams of carbs per day.

In terms of the safety of the intervention, one patient lost weight while two patients experienced diarrhoea.

About 33 percent of the patients dropped out from the study due to poor tolerance of the diet, lack of benefit, or the inability to follow-up in part due to COVID-19. However, Tripathi noted that the tolerance of the modified Atkins diet in their study was better than what had been seen with the ketogenic diet.

“While the modified Atkins diet may be an effective treatment in controlling seizures, further research is needed to identify genetic biomarkers and other factors associated with the response to this diet,” Tripathi said. “This may improve patient care by encouraging targeted precision based on earlier use of this diet.”

The study was limited by the self-reported or caregiver-reported nature of seizures.